Health Data Access, Transparency, and Affordability Act of 2026
- Bill Number
- H.R. 9228
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-25: Ordered to be Reported (Amended) by the Yeas and Nays: 18 - 15.
- Last Updated
- 2026-07-02T04:54:14Z
AI-Generated Summary
Purpose This legislation amends the Employee Retirement Income Security Act of 1974 (ERISA) to require that contracts between group health plans and service providers allow plan fiduciaries and their agents to access detailed health claims data, encounter information, and related pricing details. The goal is to promote greater transparency in health plan administration and claims processing.
Key Provisions
- Defines "network service provider" broadly to include third-party administrators, pharmacy benefit managers, insurers, and other entities that contract with group health plans (with an exception for direct health care providers).
- Requires that any contract or arrangement for services must grant the responsible plan fiduciary and designated agents timely access to all claims, encounter data, supporting documentation, pricing terms, overpayment information, and payment methodologies.
- Prohibits contract terms that limit data access (such as delays beyond 15 days, caps on volume, restrictions on audits, or limits on disclosure of fees), and voids any such restrictive provisions as against public policy.
- Mandates data formats consistent with HIPAA transaction standards (e.g., ASC X12N 837 for claims, 835 for payments) and requires itemized non-claim costs to be available in real time via portals or downloadable files.
- Adds civil penalties of up to $10,000 per day for violations by service providers and prohibits indemnification of parties subject to penalties.
- Updates annual attestation requirements so plans must confirm compliance with data access rules and cannot outsource the attestation to a third party.
- Applies to plans starting with the first plan year beginning at least one year after enactment.
Significant Changes to Existing Law
- Strengthens ERISA Section 408(b)(2) by adding explicit data access requirements and limitations on contract terms for group health plans.
- Introduces new enforcement tools in Section 502(c), including daily civil penalties for data access violations.
- Amends Section 410 to void contract provisions that restrict data access or violate the new rules and bars indemnification for certain penalties.
- Modifies Section 724 attestation rules to prevent gag clauses and require direct plan responsibility for compliance statements.
Potential Impacts
- Government agencies: Increases the Department of Labor’s oversight and enforcement role through rulemaking authority and penalty assessments.
- Citizens: May improve plan sponsors’ ability to review claims, identify errors or fraud, and negotiate better terms, potentially affecting health care costs for plan participants.
- No direct effects on international relations are addressed in the legislation.
Main Stakeholders Affected
- Group health plan fiduciaries, sponsors, and administrators.
- Network service providers (third-party administrators, pharmacy benefit managers, insurers, and similar entities).
- Employees and beneficiaries covered by ERISA-regulated group health plans.
- The Secretary of Labor, who gains enforcement responsibilities.
Notable Legal, Constitutional, or Political Implications
- Reinforces ERISA fiduciary duties by mandating access to information needed for plan oversight while requiring ongoing compliance with HIPAA privacy and security rules.
- Creates new private contract restrictions and public policy voids that could affect existing and future service agreements.
- Emphasizes plan-level accountability by limiting delegation of attestation duties and adding direct penalties on service providers.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Onder, Robert F. [R-MO-3]
Recent Actions
- 2026-06-25: Ordered to be Reported (Amended) by the Yeas and Nays: 18 - 15.
- 2026-06-25: Committee Consideration and Mark-up Session Held
- 2026-06-09: Referred to the House Committee on Education and Workforce.
- 2026-06-09: Introduced in House
- 2026-06-09: Introduced in House
Bill Versions
- Health Data Access, Transparency, and Affordability Act of 2026 — issued 2026-06-09 — PDF (14 pages)